Narrative Review on Causes of Obesity Prevalence in Ethnic Indians and Strategies to Prevent It
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Running head: NARRATIVE REVIEW
Narrative review on causes of obesity prevalence in ethnic Indians and strategies to prevent it
Name of the student:
Name of the University:
Author’s note
Narrative review on causes of obesity prevalence in ethnic Indians and strategies to prevent it
Name of the student:
Name of the University:
Author’s note
1NARRATIVE REVIEW
Table of Contents
1. Introduction:................................................................................................................................2
Background:.................................................................................................................................2
Significance of the study:............................................................................................................4
Research Gap of previous studies:...............................................................................................5
Research questions:.....................................................................................................................8
Research aim:...............................................................................................................................9
Research objective.......................................................................................................................9
2.Methodology:..............................................................................................................................10
Research design:............................................................................................................................10
Search strategy:..........................................................................................................................11
Data collection:..........................................................................................................................12
Data analysis..............................................................................................................................13
Results............................................................................................................................................14
Trends in obesity in India..........................................................................................................14
Dietary habits and obesity.........................................................................................................15
Genetic factors and obesity........................................................................................................17
Ethnicity and Obesity................................................................................................................18
Physical activity and obesity.....................................................................................................20
Sugar intake and obesity............................................................................................................22
Table of Contents
1. Introduction:................................................................................................................................2
Background:.................................................................................................................................2
Significance of the study:............................................................................................................4
Research Gap of previous studies:...............................................................................................5
Research questions:.....................................................................................................................8
Research aim:...............................................................................................................................9
Research objective.......................................................................................................................9
2.Methodology:..............................................................................................................................10
Research design:............................................................................................................................10
Search strategy:..........................................................................................................................11
Data collection:..........................................................................................................................12
Data analysis..............................................................................................................................13
Results............................................................................................................................................14
Trends in obesity in India..........................................................................................................14
Dietary habits and obesity.........................................................................................................15
Genetic factors and obesity........................................................................................................17
Ethnicity and Obesity................................................................................................................18
Physical activity and obesity.....................................................................................................20
Sugar intake and obesity............................................................................................................22
2NARRATIVE REVIEW
Socioeconomic status and obesity prevalence...........................................................................23
Television ownership and TV time:..........................................................................................24
Strategies to prevent obesity in ethnic Indian population..........................................................25
Socioeconomic status and obesity prevalence...........................................................................23
Television ownership and TV time:..........................................................................................24
Strategies to prevent obesity in ethnic Indian population..........................................................25
3NARRATIVE REVIEW
1. Introduction:
Obesity has become a growing public health issue because of related co-morbidities
associated with the condition and increase in health expenditure related to the allocation of health
care resources for the management of obesity. A person is defined as obese when his body mass
index (BMI) is greater than 30kg/m2. Furthermore, extreme obesity is diagnosed when a person
has BMI of greater than 40 kg/m2 (1). Although it is a high burden for high income countries,
however the prevalence of obesity in middle and low income countries is also turning out to be a
burden for public health department. According to World Health Organization (WHO), obesity is
a highly neglected problem in developed and developing countries (2). In case of India, ethnic
difference in obesity has been found as a research study revealed regional differences in obesity
statistics and its risk for North Indians, South Indians and North East Indians (3). As obesity is
associated with many co-morbid health conditions like type 2 diabetes, hypertension and non-
alcoholic fatty liver disease, taking adequate steps to understand the cause behind prevalence of
obesity in specific section of population is important (4). Childhood obesity is also an issue as it
is a precursor to obesity and non-communicable disease. As obesity epidemic is increasing in
Indians, the main purpose of this dissertation is to look at the issue of high prevalence of obesity
in ethnic Indian population and conduct a narrative review of research literatures to understand
the factors that contribute to obesity in ethnic Indian population. The process of narrative review
will help to critically understand the facilitators of obesity and identify strategies that can be
implemented to prevent obesity and make people aware about the risk associated with obesity.
1. Introduction:
Obesity has become a growing public health issue because of related co-morbidities
associated with the condition and increase in health expenditure related to the allocation of health
care resources for the management of obesity. A person is defined as obese when his body mass
index (BMI) is greater than 30kg/m2. Furthermore, extreme obesity is diagnosed when a person
has BMI of greater than 40 kg/m2 (1). Although it is a high burden for high income countries,
however the prevalence of obesity in middle and low income countries is also turning out to be a
burden for public health department. According to World Health Organization (WHO), obesity is
a highly neglected problem in developed and developing countries (2). In case of India, ethnic
difference in obesity has been found as a research study revealed regional differences in obesity
statistics and its risk for North Indians, South Indians and North East Indians (3). As obesity is
associated with many co-morbid health conditions like type 2 diabetes, hypertension and non-
alcoholic fatty liver disease, taking adequate steps to understand the cause behind prevalence of
obesity in specific section of population is important (4). Childhood obesity is also an issue as it
is a precursor to obesity and non-communicable disease. As obesity epidemic is increasing in
Indians, the main purpose of this dissertation is to look at the issue of high prevalence of obesity
in ethnic Indian population and conduct a narrative review of research literatures to understand
the factors that contribute to obesity in ethnic Indian population. The process of narrative review
will help to critically understand the facilitators of obesity and identify strategies that can be
implemented to prevent obesity and make people aware about the risk associated with obesity.
4NARRATIVE REVIEW
Background:
India is the second most populated country in the world and great diversity exist in terms
of populations statistics as different ethnic groups like Mongoloid, Dravidians and Indo-Aryans
reside in the country (5). As India is a multi-ethnic country, a research study aimed to explore
about ethnic difference in obesity through analysis of differences in socio-cultural background.
Variations in ethnic groups were examined in three different ethnic groups residing in Manipur,
Delhi and Kerala. Females in Delhi were found to be the heaviest followed by Manipur and
Kerala (6). The variations in adiposity patterns were justified by the contribution of genetic
factors and environmental sources in causing obesity (7). Hence, the findings gave the
implication that ethnicity is a complex construct and many factors unique to ethnic group socio-
cultural environment might also help to identify the cause behind obesity in Indians. Therefore,
more research work on factors contributing to obesity in ethnic population group will be
importance.
A review of research on obesity prevalence and trends in Indian population revealed that
obesity and overweight issues in children are increasing and the problem is evident not only for
children coming from higher socio-economic group, but also for people under the low income
group (8). High consumption of energy rich food, sedentary lifestyle, genetic, behavioural and
environmental factors play a role in the pathogenesis of obesity (9). This can eventually lead to
poor health in future such as mental disorders, respiratory issues and glucose intolerance. The
study revealed that there is a trend towards increase in obesity (8). However, the limitation of the
work was that it lacked data related to ethnic wise and gender wise differences. Hence, to get
better understanding regarding obesity trend in India, there is a need to compare data related to
ethnic specific cut points and gender related difference to identify the cause behind obesity. For
Background:
India is the second most populated country in the world and great diversity exist in terms
of populations statistics as different ethnic groups like Mongoloid, Dravidians and Indo-Aryans
reside in the country (5). As India is a multi-ethnic country, a research study aimed to explore
about ethnic difference in obesity through analysis of differences in socio-cultural background.
Variations in ethnic groups were examined in three different ethnic groups residing in Manipur,
Delhi and Kerala. Females in Delhi were found to be the heaviest followed by Manipur and
Kerala (6). The variations in adiposity patterns were justified by the contribution of genetic
factors and environmental sources in causing obesity (7). Hence, the findings gave the
implication that ethnicity is a complex construct and many factors unique to ethnic group socio-
cultural environment might also help to identify the cause behind obesity in Indians. Therefore,
more research work on factors contributing to obesity in ethnic population group will be
importance.
A review of research on obesity prevalence and trends in Indian population revealed that
obesity and overweight issues in children are increasing and the problem is evident not only for
children coming from higher socio-economic group, but also for people under the low income
group (8). High consumption of energy rich food, sedentary lifestyle, genetic, behavioural and
environmental factors play a role in the pathogenesis of obesity (9). This can eventually lead to
poor health in future such as mental disorders, respiratory issues and glucose intolerance. The
study revealed that there is a trend towards increase in obesity (8). However, the limitation of the
work was that it lacked data related to ethnic wise and gender wise differences. Hence, to get
better understanding regarding obesity trend in India, there is a need to compare data related to
ethnic specific cut points and gender related difference to identify the cause behind obesity. For
5NARRATIVE REVIEW
developing country like India, the challenges is that it has been already dealing with malnutrition
and underweight issues and the latest trend of obesity in children is a new unique challenge for
public health. Hence, it can be said that India is undergoing both epidemiological and nutritional
transitions now and gaining an in-depth understanding regarding the impact of this transition on
obesity is important.
Research study investigating about cause of obesity has revealed lack of awareness
regarding obesity and increased attitude towards consuming unhealthy food are some of the
cause behind increase in prevalence of obesity (10). Another rational for the significance of this
research project is that findings obtained from this project can indirectly help to reduce the
burden of non-communicable disease (NCD) too (11). This is said because of the links between
obesity and NCD. Obesity and being overweight is one of the modifiable risk factors of obesity
and reducing the rate of obesity is one of the approach to ameliorate rate of NCDs in community
too (12). According to recent data, NCD accounted for 6.7 million deaths in South East Asia
Region in 2012 (13). Obesity and sedentary lifestyle has been identified as the major risk factors
of NCD. In rural areas too, gradual shift in lifestyle has been seen because of the advent of mass
media and modernization. Mass media is a powerful mechanism that changes taste and
preferences and interest of the people (14). Therefore, identifying the influence of changing
dietary patterns and level of physical activity in the context of demographic transition in India is
important.
Significance of the study:
Many research studies have explored the cause of obesity prevalence because of changes
in nutrition profile of India. However, many limitations or shortcomings in those research
pointed out to the need for conducting research on cause behind obesity prevalence in ethnic
developing country like India, the challenges is that it has been already dealing with malnutrition
and underweight issues and the latest trend of obesity in children is a new unique challenge for
public health. Hence, it can be said that India is undergoing both epidemiological and nutritional
transitions now and gaining an in-depth understanding regarding the impact of this transition on
obesity is important.
Research study investigating about cause of obesity has revealed lack of awareness
regarding obesity and increased attitude towards consuming unhealthy food are some of the
cause behind increase in prevalence of obesity (10). Another rational for the significance of this
research project is that findings obtained from this project can indirectly help to reduce the
burden of non-communicable disease (NCD) too (11). This is said because of the links between
obesity and NCD. Obesity and being overweight is one of the modifiable risk factors of obesity
and reducing the rate of obesity is one of the approach to ameliorate rate of NCDs in community
too (12). According to recent data, NCD accounted for 6.7 million deaths in South East Asia
Region in 2012 (13). Obesity and sedentary lifestyle has been identified as the major risk factors
of NCD. In rural areas too, gradual shift in lifestyle has been seen because of the advent of mass
media and modernization. Mass media is a powerful mechanism that changes taste and
preferences and interest of the people (14). Therefore, identifying the influence of changing
dietary patterns and level of physical activity in the context of demographic transition in India is
important.
Significance of the study:
Many research studies have explored the cause of obesity prevalence because of changes
in nutrition profile of India. However, many limitations or shortcomings in those research
pointed out to the need for conducting research on cause behind obesity prevalence in ethnic
6NARRATIVE REVIEW
Indian population. In the past, India suffered because of persistent burden of under-nutrition.
However, during the Millennium Development era, India witnessed rapid changes in nutrition
profile of the national population because of increase in number of obese children (15).
According to a study done on remission of overweight among men and women in India, it was
found that prevalence of overweight was 19% among men and 27.2% among women. In
addition, the remission rate was found to be highest among men compared to women. People in
the age group of 25-35 years and 36-49 years were found to have higher odds of being
overweight (16). This suggests that nutrition transition in rural East Indian district has resulted in
growth of burden due to obesity. The study gave no link regarding increased in burden due to
low socioeconomic status. However, the factors leading to increase in obesity in ethnic Indian
population was left to be examined. Hence, these gaps in previous research literature signified
the significance of this dissertation as it aims to explore all factors that contribute to obesity in
ethnic people by conducting a narrative review of research literature.
The research in the area of cause behind rise in obesity in ethnic population in India is
significant as it could pave way to understand socio-cultural, environmental and behavioural
factors that encourage people to consume unhealthy food and increase their odds of being obese.
To identify specific preventive strategies needed to reduce obesity prevalence, more extensive
research on wider ethnic population in India is needed to gain an insight regarding the cause of
obesity prevalence among ethnic Indian adults. The narrative review method can help to
understand specific factors that contribute to the burden of obesity in specific population of India
such as the young age group and the ethnic group.
Indian population. In the past, India suffered because of persistent burden of under-nutrition.
However, during the Millennium Development era, India witnessed rapid changes in nutrition
profile of the national population because of increase in number of obese children (15).
According to a study done on remission of overweight among men and women in India, it was
found that prevalence of overweight was 19% among men and 27.2% among women. In
addition, the remission rate was found to be highest among men compared to women. People in
the age group of 25-35 years and 36-49 years were found to have higher odds of being
overweight (16). This suggests that nutrition transition in rural East Indian district has resulted in
growth of burden due to obesity. The study gave no link regarding increased in burden due to
low socioeconomic status. However, the factors leading to increase in obesity in ethnic Indian
population was left to be examined. Hence, these gaps in previous research literature signified
the significance of this dissertation as it aims to explore all factors that contribute to obesity in
ethnic people by conducting a narrative review of research literature.
The research in the area of cause behind rise in obesity in ethnic population in India is
significant as it could pave way to understand socio-cultural, environmental and behavioural
factors that encourage people to consume unhealthy food and increase their odds of being obese.
To identify specific preventive strategies needed to reduce obesity prevalence, more extensive
research on wider ethnic population in India is needed to gain an insight regarding the cause of
obesity prevalence among ethnic Indian adults. The narrative review method can help to
understand specific factors that contribute to the burden of obesity in specific population of India
such as the young age group and the ethnic group.
7NARRATIVE REVIEW
Research Gap of previous studies:
Many research studies have explored obesity prevalence and identified links between
social and environmental factors contributing to obesity. A recently published research literature
gave the idea that India is dealing with the pressure of both over nutrition and under nutrition. In
some areas, energy deficiency is an issue affecting population health whereas in other areas
obesity and its associated disease is acting as a public health problem. In a period of 14 years,
rapid change in obesity prevalence has been seen in the rural population. The main reasons
behind this change are improve in transport facilities, family income, educational status and food
habits (17). Another research study investigated about the prevalence of obesity in ethnic groups
such South Asian Indians and Africans by measuring data related to body weight, height and
waist circumferences. Gender specific differences in ethnic Indian population were found.
However, the researcher argued that effective implementation of obesity prevention strategies are
hampered because of misclassification about adiposity excess and disease risk (18). Hence, there
is a need to take into account gender and ethnicity while reviewing epidemiological data on
obesity in Indian population. A better interpretation of numbers and statistics is necessary to
identify the risk factors of obesity and address barriers that impede prevention of obesity for
youths and adults in the Indian community.
Obesity is a condition that is influenced by multiple factors like genetic, demographic and
lifestyle factors. Although genetic factors and demographic factors like ethnicity and age cannot
be modified, however lifestyle factors are modifiable (19). For this reason, a study evaluated
about socioeconomic, demographic and lifestyle determinant of obesity in Northeast Indian. The
cross-sectional study with Rengma-Naga individuals living in Assam revealed an association
between age, education and income. Rapid urbanization and changes in lifestyle because of
Research Gap of previous studies:
Many research studies have explored obesity prevalence and identified links between
social and environmental factors contributing to obesity. A recently published research literature
gave the idea that India is dealing with the pressure of both over nutrition and under nutrition. In
some areas, energy deficiency is an issue affecting population health whereas in other areas
obesity and its associated disease is acting as a public health problem. In a period of 14 years,
rapid change in obesity prevalence has been seen in the rural population. The main reasons
behind this change are improve in transport facilities, family income, educational status and food
habits (17). Another research study investigated about the prevalence of obesity in ethnic groups
such South Asian Indians and Africans by measuring data related to body weight, height and
waist circumferences. Gender specific differences in ethnic Indian population were found.
However, the researcher argued that effective implementation of obesity prevention strategies are
hampered because of misclassification about adiposity excess and disease risk (18). Hence, there
is a need to take into account gender and ethnicity while reviewing epidemiological data on
obesity in Indian population. A better interpretation of numbers and statistics is necessary to
identify the risk factors of obesity and address barriers that impede prevention of obesity for
youths and adults in the Indian community.
Obesity is a condition that is influenced by multiple factors like genetic, demographic and
lifestyle factors. Although genetic factors and demographic factors like ethnicity and age cannot
be modified, however lifestyle factors are modifiable (19). For this reason, a study evaluated
about socioeconomic, demographic and lifestyle determinant of obesity in Northeast Indian. The
cross-sectional study with Rengma-Naga individuals living in Assam revealed an association
between age, education and income. Rapid urbanization and changes in lifestyle because of
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